AG Healey Settles with Mental Health Provider Over Alleged False Claims

Cozen O'Connor
Contact

Cozen O'Connor

  • Massachusetts AG Maura Healey and the DOJ reached a settlement with outpatient mental health company Pathways of Massachusetts, LLC (“Pathways”) and its former parent company Molina Healthcare, Inc. (“Molina”) to resolve allegations that Pathways submitted fraudulent claims to Massachusetts’ Medicaid program in violation of the federal and Massachusetts False Claims Acts.  The settlement further resolved allegations regarding the same conduct set forth in a qui tam action brought by four realtors.
  • According to the settlement agreement, the AG’s office found that Pathways submitted claims for payment to Massachusetts’ Medicaid program, MassHealth, during a period of time when Pathways was in violation of staff qualification and staff supervision regulatory requirements. Because of this, Pathways facilities were in violation of mental health canter licensure requirements and the center did not qualify as an eligible mental health center under MassHealth and Massachusetts Department of Public Health regulations, and thus claims submitted during this time contained implied false certifications that resulted in MassHealth overpaying.
  • Under the terms of the settlement, Molina and Pathways will pay $4,625,000 to the United States and the Commonwealth of Massachusetts. The four whistleblowers will receive a payment of $810,000 and are free to pursue additional claims of reasonable expenses, attorneys’ fees and costs, as well as employment retaliation claims. Molina and Pathways also agree not to submit unallowable costs in the future.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Cozen O'Connor | Attorney Advertising

Written by:

Cozen O'Connor
Contact
more
less

Cozen O'Connor on:

Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
- hide
- hide

This website uses cookies to improve user experience, track anonymous site usage, store authorization tokens and permit sharing on social media networks. By continuing to browse this website you accept the use of cookies. Click here to read more about how we use cookies.